{ "schema_version": 1, "kind": "condition", "id": "hypertensive-retinopathy", "name": "Hypertensive (arteriosclerotic) retinopathy", "category": "chronic", "sources": "Hypertensive Retinopathy - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK525980/ · Egyptian National Drug Formulary - Cardiovascular Chapter 2024 (amlodipine monograph, Hypertension, chronic) · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class FD67.00 - condition scope only, no dose", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Cardiovascular Chapter 2024 (amlodipine monograph, Hypertension, chronic) · Hypertensive Retinopathy - StatPearls - NCBI Bookshelf (NBK525980) - https://www.ncbi.nlm.nih.gov/books/NBK525980/, Treatment / Management", "verified_date": "2026-09", "treatments": [ { "id": 971, "generic": "Amlodipine", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "2.5 to 5 mg once daily initially; evaluate the response after 2 to 4 weeks and titrate as needed to a maximum of 10 mg once daily. If more control is needed, consider combination therapy", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Cardiovascular Chapter 2024 (amlodipine monograph, Hypertension, chronic). That blood pressure control is the treatment for this condition, and the classes used for it, come from Hypertensive Retinopathy - StatPearls - NCBI Bookshelf (NBK525980) - https://www.ncbi.nlm.nih.gov/books/NBK525980/, Treatment / Management", "rationale": "The retinopathy is the eye's record of the blood pressure, so the treatment is the blood pressure. The article: \"Hypertensive retinopathy, including papilledema and macular subfoveal fluid, often improves with adequate systemic control, particularly blood pressure regulation and management of renal dysfunction\" and \"Primary drug classes for long-term blood pressure control include angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, thiazide diuretics, and calcium channel blockers.\" A calcium-channel blocker is one of those four and needs no electrolyte monitoring, which suits a first prescription; the fuller comparison of antihypertensives is on the hypertension card.", "cautions": [ "RED FLAG - Untreated malignant hypertensive retinopathy is lethal, not just a threat to sight. The article: \"In untreated malignant cases, mortality reaches up to 50% within 2 months and nearly 90% within 1 year of diagnosis.\" Retinal findings of this severity are a reason for urgent referral and urgent treatment, not a routine follow-up.", "RED FLAG - In a hypertensive crisis the pressure is lowered in a controlled way, not abruptly. The article: \"Most guidelines recommend reducing the mean arterial pressure (MAP) by 10% to 15% in the first hour and no more than 25% of baseline within the first 24 hours during a hypertensive crisis\", because a faster drop causes ischaemic injury to the optic nerve, kidneys and brain. Management there begins with intravenous drugs in hospital - the article names labetalol, nicardipine, clevidipine, fenoldopam, esmolol and sodium nitroprusside - and transitions gradually to oral agents. That is a hospital job, and no intravenous dose is printed here.", "Ankle oedema is dose-related and common with amlodipine. Avoid in severe aortic stenosis, and use the lower starting dose in severe hepatic impairment. No dose change is needed for any degree of kidney impairment.", "Look for what else is damaging the same vessels. The article says moderate cases warrant referral to a physician to evaluate coexisting diabetes mellitus and cardiovascular abnormalities, and that assessment of target-organ damage in the kidneys, cardiovascular system and brain is critical.", "Some retinal change does not reverse. \"Retinal changes can stabilize with effective treatment of hypertension, although arteriolar narrowing and vessel crossing changes often remain\" - so a persistent finding on a later fundoscopy is not proof the treatment failed." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary licenses amlodipine for hypertension in children of 6 years and over, and gives a set amount rather than a weight-based one: \"Children >=6 years and Adolescents: Oral: Initial: 2.5 mg once daily; titrate based on clinical response; maximum dose: 10 mg/day.\" Hypertensive retinopathy in a child is unusual and points to a secondary cause, so the reason for the hypertension is the thing to chase.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": 72.0, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CORONAVINE 5 MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 6.0, "pack_count": 10, "unit_price": 0.6, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINDIPINE 5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 21.0, "pack_count": 30, "unit_price": 0.7, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VASOPINE 5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 24.0, "pack_count": 30, "unit_price": 0.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMILO 5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 54.0, "pack_count": 30, "unit_price": 1.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMLODIPINE 5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MYODURA 5 MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > WOCKHARDT", "price_egp": 69.0, "pack_count": 30, "unit_price": 2.3, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NORVASC 5MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER > VIATRIS EGYPT", "price_egp": 54.0, "pack_count": 10, "unit_price": 5.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NORVASC 5MG 30 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER > VIATRIS EGYPT", "price_egp": 162.0, "pack_count": 30, "unit_price": 5.4, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "hypertensive-retinopathy" }, { "id": 972, "generic": "Grading, eye referral and the systemic work-up (Referral & Advice)", "line": 2, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Retinal changes from long-standing or poorly controlled hypertension; hypertension is extremely common in Egyptian primary care. The GP's actionable step is tightening blood pressure control with the drug above, and referring to ophthalmology for grading and monitoring. The article sets the referral threshold by severity: mild cases are managed with blood pressure control and regular monitoring; moderate cases warrant referral to a physician to look for coexisting diabetes and cardiovascular disease; severe cases demand urgent intervention and referral.", "adult_duration": "Refer, with advice", "dose_source": "No dose - grading and referral pathway, from Hypertensive Retinopathy - StatPearls - NCBI Bookshelf (NBK525980) - https://www.ncbi.nlm.nih.gov/books/NBK525980/, Treatment / Management", "rationale": "Retinal changes from long-standing or poorly controlled hypertension; hypertension is extremely common in Egyptian primary care. The GP's actionable step is tightening blood pressure control with the drug above, and referring to ophthalmology for grading and monitoring. The article sets the referral threshold by severity: mild cases are managed with blood pressure control and regular monitoring; moderate cases warrant referral to a physician to look for coexisting diabetes and cardiovascular disease; severe cases demand urgent intervention and referral.", "cautions": [ "Systemic control comes first, before any eye injection. The article reports intravitreal bevacizumab improving macular oedema in a small case series where subfoveal fluid persisted despite adequate systemic treatment, but states that \"Systemic control should always be prioritized before considering intravitreal therapy, given the associated risks, including endophthalmitis and potential blood pressure dysregulation\", and that the role of anti-VEGF agents requires further investigation. This is an ophthalmologist's decision, not a primary-care one.", "The fundus is not proof of the cause. Optic disc swelling also occurs in idiopathic intracranial hypertension, anterior ischaemic optic neuropathy, optic neuritis, central retinal vein occlusion, diabetic papillopathy, neuroretinitis, radiation papillopathy and a retrobulbar tumour; and chronic hypertensive change is mimicked by diabetic retinopathy, retinal venous obstruction, hyperviscosity syndrome, ocular ischaemic syndrome, radiation retinopathy and anaemia.", "Chronic hypertensive retinopathy rarely causes significant visual loss - which is worth saying to a frightened patient - but the same article gives the malignant form a mortality of up to 50% at 2 months untreated. The grading is what separates those two conversations." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The pathway is the same in a child, and the amlodipine row above carries the paediatric dose from 6 years. Hypertension severe enough to mark the retina in a child needs its cause found.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "hypertensive-retinopathy" } ] }